The present invention relates generally to body tissue stabilization using a suction support system, and more particularly, relates to using the system to stabilize the aorta and right atrium by providing countertraction during minimally invasive cardiac surgery.
Coronary artery bypass grafting (CABG) is a well-established procedure for patients with ischemic heart disease. However, significant mortality and morbidity still exists due to the use of cardiopulmonary bypass for circulating support and the traditional method of access by medium sternotomy. Minimally invasive surgical procedures using an endoscopic approach have been adopted in cardiac surgery in an attempt to make these procedures less invasive. In port-access approach, minimal access incisions are made in the intercostal space for insertion of various endoscopic instruments, and cardiopulmonary support is instituted through an extrathoracic approach.
The right atrium and the ascending aorta are often cannulated in preparation for cardiopulmonary bypass (CPB). In order to cannulate the right atrium and the aorta, incisions have to be made on these soft and pulsating tissues. It is difficult, however, to make such incisions because these tissues are moving during such procedures. Moreover, because the aorta, and other tissues, are soft and pliable, the aorta will compress when a device, such as a blade or cannula, presses against it. A need for devices and methods therefore exists to endoscopically assist the surgeon in stabilizing pliable and/or moving tissue by providing countertraction.
The present invention relates to an endoscopic stabilization device having an ability to hold a soft, moving body tissue in place while the tissue is being operated on. More particularly, this device is a suction support comprising an elongate tubular member having a proximal end, a distal end, and a lumen therebetween. An arcuate member is joined to the distal end of the tubular member and has a lumen which communicates with the lumen of the elongate member. A plurality of suction ports is disposed along the arcuate member and communicates with the lumen of the arcuate member. The proximal end of the suction support is adapted for attachment to a vacuum. The elongate member and the arcuate member are generally joined at an angle between 45xc2x0 to 135xc2x0.
In an alternative embodiment, the suction support has an additional lumen attached along its elongate member for insertion of a surgical blade to incise the aorta or right atrium at its distal opening. A further alternative suction support has an additional lumen with a surgical blade which is mounted at its distal end and communicates with the proximal end. The blade is pushed forward to incise the atrium and the aorta, and retracted back into the lumen when manipulated at the proximal end. As a force is exerted on the aorta or atrium by probing the blade forward, a counter-force is exerted by the suction support, thereby stabilizing the moving aorta or atrium for a precise incision.
The present invention also provides methods for stabilizing a body tissue during surgery. The methods employ a suction support comprising an elongate member having a plurality of suction ports and joined to a distal end of the tubular member. The suction support is generally introduced into a patient""s thoracic cavity through an incision, preferably an intercostal incision, and is positioned about a body tissue, such as the aorta or heart. Vacuum is applied to the lumen of the elongate tubular member wherein the body tissue becomes releasably engaged by the suction ports. The body tissue is released from the suction port by removing the vacuum. During minimally invasive CABG, the right atrium and ascending aorta are the body tissues of interest requiring stabilization before cannulation or CPB.
The present invention also provides methods for making an incision on the body tissue for cannulation after stabilization by the suction support. The surgical blade, optionally contained in a lumen, can be manipulated from the proximal end to incise the aorta or the right atrium while the suction support provides countertraction.
In an alternative embodiment wherein an introducer is attached to the suction support, the suction support also provides countertraction on the aorta and right atrium during introducer insertion. The steps of stabilizing, incising a body tissue, and inserting an introducer can be achieved sequentially on one track, therefore providing a simplified surgical method for cannulation for CPB. In a still further embodiment, the suction support can be attached to a trocar for visualization into a patient""s chest cavity.